[Public service and socialized medicine].
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Increasing health care costs are forcing collegiate institutions to find more economical ways to meet the health care needs of students. Student health insurance programs are a major component in meeting these needs. This national survey reports the extent to which student health insurance programs are offered or administered by 2-year and 4-year colleges, universities, and professional and graduate schools in both the public and private sectors. The study finds that most programs are optional, open to all registered students regardless of age or credit load, with dependent coverage options usually available. Reported enrollment levels suggest that less than 20% of the students participate at a majority of the institutions surveyed. Concern about group health insurance at the collegiate level reflects national concern over the large number of Americans who currently lack health coverage.
The National Institute of Environmental Health Sciences (NIEHS) has several new initiatives involving chemical mixtures and has recognized the need to develop new experimental approaches to enhance our efforts in this area. Responding to recent increases in nominations of complex occupational exposures for toxicologic assessment by the U.S. National Toxicology Program, the NIEHS and the National Institute for Occupational Safety and Health have begun a program to characterize exposures through field studies, identify biomarkers of exposure in workers, and recreate relevant mixed exposures in a laboratory setting. A second initiative with the National Center for Environmental Health/Centers for Disease Control and Prevention will examine blood samples from the U.S. National Health and Nutrition Examination Survey population surveys for selected endocrine-disrupting agents and for common patterns of persistent xenobiotics, providing critical information for the design of animal studies to assess risks of relevant chemical mixtures to humans. New toxicology testing methods (lower cost, faster) will enhance our ability to study chemical mixtures (e.g., dioxin and dioxinlike chemicals, combination AIDS therapies). Ongoing method development efforts involve in vitro functional toxicology assays, screens for estrogenic activity, and carcinogenesis studies in transgenic mice. A major scientific initiative with mixtures involves studies of individual and mixtures of dioxin and dioxinlike chemicals to determine if toxic equivalence factors predict carcinogenic potency in traditional and transgenic bioassays. Complementing these studies is an increased emphasis on physiologically based pharmacokinetic modeling, an activity central to the proper interpretation of chemical mixture studies.
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